Truni

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Truni

  1. 1. Dolore in corso di Sindrome di Ehlers Danlos – Variante ipermobile A Truini Department of Neurology and Psychiatry, Sapienza University, Rome Disclosure: No conflict of interest to declare
  2. 2. Anatomia e Fisiologia del Sistema Nocicettivo
  3. 3. Five types of pain • • • • • Nociceptive Neuropathic Mixed Psychogenic Idiopathic/Putative/Dysfucntional
  4. 4. Five types of pain • • • • • Nociceptive Neuropathic Mixed Psychogenic Idiopathic/Putative
  5. 5. Nociceptive pain
  6. 6. Five types of pain • • • • • Nociceptive Neuropathic Mixed Psychogenic Idiopathic/Putative/Dysfucntional
  7. 7. Neuropathic pain Neuropathic pain is pain arising as a direct consequence of a lesion or disease affecting the somatosensory system Treede et al., Neurology 2008
  8. 8. Clinical diagnosis Peroneal mononeuropathy L5- radiculopathy Saphenous mononeuropathy L3- radiculopathy Brachial plexopathy Polyneuropathy Myelopathy Amiotrophy Herpes Zoster Musculoskeletal pain
  9. 9. Five types of pain • • • • • Nociceptive Neuropathic Mixed Psychogenic Idiopathic/Putative/Dysfunctional
  10. 10. Che dolore hanno le persone con ED? Può essere un dolore neuropatico? Our preliminary findings are apparently in contrast with common sense, that is, in EDS, pain is directly linked to primary joint damage and, consequently, is mainly nociceptive in origin. In fact, our results suggest that pain is frequently neuropathic. This implies that the pathophysiology of pain in EDS may be more complex than expected, and that musculoskeletal involvement cannot explain the entire spectrum of pain. Accordingly, it is likely that pain symptoms in EDS are the result of different pain-triggering mechanisms. Camerota et al., J Pain Symptom Manag 2010
  11. 11. Indagini strumentali Quantitative Sensory Testing (Aδ- and C fibres mediated) C-fibres Aδ-fibres Aβ-fibres NCS (Aβ-fibre mediated) Laser evoked potentials (Aδ-fibre mediated)
  12. 12. Questionari DN4 Questionnaire Fibromyalgia Rapid Screening Tool (FiRST) Does my pain have one or more of the following characteristics? Items 1. Burning Y N 2. Painful cold Y N 3. Electric shocks Y N Is the pain associated with one or more of the following symptoms in the same area? Y N 5. Pins and needles Y N 6. Numbness Y N 7. Itching Y N 8. Hypoesthesia to touch Y N 9. Hypoesthesia to prick Y N Is the pain located in an area where the physical examination reveals one or more of the following? In the painful area, can the pain caused or increased by Y My pain is accompanied by a continuous and very unpleasant general fatigue My pain feels like burns, electric shocks or cramps 4. Tingiling 10. Brushing I have pain all over my body N My pain is accompanied by other unusual sensations throughout my body, such as pins and needles, tingling or numbness My pain is accompanied by other health problems such as digestive problems, urinary problems, headaches or restless legs My pain has a significant impact on my life, particularly on my sleep and my ability to concentrate, making me feel slower generally Y/N
  13. 13. Risultati In tutti i soggetti con sindrome di Ehlers Danlos studiati DN4, visita clinica neurologica, studio di conduzione nervosa, dei potenziali evocati laser e delle soglie percettive termodolorifiche sono risultati normali Distribuzione topografica dolore Fibromyalgia Rapid Screening Tool (FiRST) Items Y/N (%) I have pain all over my body 80 My pain is accompanied by a continuous and very unpleasant general fatigue 90 My pain feels like burns, electric shocks or cramps 90 My pain is accompanied by other unusual sensations throughout my body, such as pins and needles, tingling or numbness 90 My pain is accompanied by other health problems such as digestive problems, urinary problems, headaches or restless legs 90 My pain has a significant impact on my life, particularly on my sleep and my ability to concentrate, making me feel slower generally 90
  14. 14. Discussione
  15. 15. Discussione Infiammazione cronica Persistente attivazione del sistema dolorifico Sviluppo della sensitizzazione centrale
  16. 16. Functional connectivity of PAG in fibromyalgia Controls Patients Controls > Patients

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